title: Effect of onabotulinumtoxinA treatment on symptoms and urodynamic findings in pediatric neurogenic bladder.
abstract: OBJECTIVE
  To evaluate clinical and urodynamic efficiency of onabotulinumtoxinA (Botox) treatment in pediatric patients with urinary incontinence due to neurogenic overactive bladder.
  
  
  METHODS
  Seventeen patients aged from 6 to 17 years (median 11 years) were treated with Botox injections. Clinical response to incontinence, duration of the response, and urodynamic results before and 1-3 months after treatment were evaluated.
  
  
  RESULTS
  Mean incontinence frequency decreased significantly (p = 0.036); six of 17 patients had >90% reduction, and a further three patients had a 50-90% reduction in incontinence episodes. Median duration of the response was 15 months (range 3-42 months). Mean bladder volume changed from 380 ± 148 ml to 453 ± 147 (p = 0.078), maximal detrusor pressure decreased from 45 ± 31 cmH2O to 32 ± 21 cmH2O (p = 0.030), and the number of patients with detrusor contractions during filling decreased from 12 to three (p = 0.005) after the treatment. The patients with poor bladder compliance had either no response or a short duration of response. At follow-up eight patients had undergone bladder augmentation because of persistent incontinence.
  
  
  CONCLUSIONS
  About one third of pediatric patients with neurogenic bladder had a good response to Botox treatment. In many patients, the clinical response was longer than expected. The patients who initially had poor bladder compliance had a poor response to the treatment.
authors.affiliation: Children's Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kask
authors.affiliation: Children's Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: R
authors.initials: R
authors.lastname: Rintala
authors.affiliation: Children's Hospital, University of Helsinki, Helsinki, Finland. Electronic address: seppo.taskinen@hus.fi.
authors.forename: S
authors.initials: S
authors.lastname: Taskinen
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003558:Cystoscopy / Q000379:methods; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D014563:Urodynamics / Q000502:physiology*
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botox; Children; Neurogenic bladder; OnabotulinumtoxinA